The purpose of this study was to evaluate a preemptive approach with serum 1,3-beta-d-glucan (BDG) as a marker for treatment stratification of systemic antifungal (AF) therapy in patients with clinical suspected invasive fungal infections (IFI) at intensive care units (ICU), and the impact of surgical procedures. A total of 66 ICU patients with clinical suspected IFI were included in this retrospective analysis. Serum BDG testing was performed prior to initiation of AF treatment and in addition to routine diagnostic measures...

RATIONALE: Life-threatening intraabdominal candidiasis (IAC) occurs in 30 to 40% of high-risk surgical intensive care unit (ICU) patients. Although early IAC diagnosis is crucial, blood cultures are negative, and the role of Candida score/colonization indexes is not established. OBJECTIVES: The aim of this prospective Fungal Infection Network of Switzerland (FUNGINOS) cohort study was to assess accuracy of 1,3-β-d-glucan (BG) antigenemia for diagnosis of IAC. METHODS: Four hundred thirty-four consecutive adults with abdominal surgery or acute pancreatitis and ICU stay 72 hours or longer were screened: 89 (20...

BACKGROUND AND AIM: Invasive fungal infection (IFI) related to surgery in elderly patients is often associated with high morbidity and mortality. The aim of the present study was to determine 1,3-β-D-glucan (βDG) levels after gastric cancer surgery in elderly patients and to prospectively evaluate the efficacy of pre-emptive antifungal therapy using βDG as an aid for the early diagnosis of IFI. METHODS: In all, 81 patients aged ≥70 years who had undergone gastric cancer surgery between 2009 and 2011 were prospectively enrolled in the study...

Invasive candidiasis is a frequent life-threatening complication in critically ill patients. Early diagnosis followed by prompt treatment aimed at improving outcome by minimizing unnecessary antifungal use remains a major challenge in the ICU setting. Timely patient selection thus plays a key role for clinically efficient and cost-effective management. Approaches combining clinical risk factors and Candida colonization data have improved our ability to identify such patients early. While the negative predictive value of scores and predicting rules is up to 95 to 99%, the positive predictive value is much lower, ranging between 10 and 60%...

Inflammatory responses are common in diabetes and are operative in angiopathy, neuropathy, and wound healing. There are indications of incomplete macrophage activation in diabetes and reduced expression of growth factors. We have previously found that up to 15 topical applications of the macrophage-stimulant, aminated β-1,3-D-glucan (AG), improved wound healing in db/db mice. The present open-label study was undertaken to examine dose-dependent effects of AG over 40 days in db/db mice. AG was given as a single dose (group 1), one dose every 10th day (group 2), five initial doses on consecutive days (group 3), and ≥15 doses (group 4)...

The purpose of this study was to investigate the interaction between intravenous ampicillin-sulbactam treatment and (1,3)-beta-D-glucan (BDG) assay. Fifteen patients with a median age of 60 (16-81) without known risk factors for invasive fungal infections who received a daily dose of 3×2g ampicillin-sulbactam monotherapy from different batches were included in the study. Thirteen patients had soft tissue infections. The 5 of 13 patients who went under surgery had surgical dressings. Serum samples were obtained both before and after antibiotic infusion on the first, third, seventh and tenth days of an ampicillin-sulbactam treatment course...

BACKGROUND/PURPOSE: Early identification and treatment of fungal infections is essential for recipients of liver transplants, but the sensitivity of surveillance culture is insufficient. Measurement of the serum level of β-D-glucan is a rapid diagnostic strategy for invasive fungal infection. We aimed to evaluate the significance of serum β-D-glucan levels in transplant recipients after living donor liver transplantation (LDLT). METHODS: We retrospectively analyzed the clinical and laboratory data of 100 consecutive adult transplant recipients after LDLT performed between August 1997 and August 2009...

BACKGROUND/AIMS: Control of infection is important in liver transplant patients under immunosuppressive conditions. In particular, invasive fungal infection is often fatal if diagnosis and therapy are delayed. The aim of this study was to analyze the incidence of fungal colonization and infection after living donor liver transplantation (LDLT). METHODOLOGY: Retrospective analysis was performed with 60 consecutive adult recipients of LDLT. RESULTS: Fungi were isolated from specimens of 16 (26...

BACKGROUND: Aortic ischemia-reperfusion (IR) is an important factor in the development of postoperative acute lung injury following abdominal aortic surgery. The aim of our study was to examine the effect of β-glucan on lung injury induced by abdominal aortic IR in rats. MATERIAL AND METHODS: Thirty-two Wistar-albino rats were randomized into four groups (eight per group) as follows: the control group (sham laparotomy), aortic IR (120 min ischemia and 120 min reperfusion), aortic IR + β-glucan (β-glucan 50 mg/kg/d for 10 d was administered orally before IR), and control + β-glucan...

The clinical efficacy of micafungin (MCFG) in surgery, emergency, and intensive-care medicine has been studied in only a limited number of cases. We conducted a multicenter postmarketing study to evaluate MCFG efficacy and safety in Japan. MCFG was given to patients with a temperature exceeding 37.5 degrees C, either with a proven fungal infection based on mycological or histopathological examination, or those who were regarded as having probable or possible fungal infections (patients who had at least one high-risk factor for the development of a systemic fungal infection and for whom fungi had been detected at multiple sites by surveillance culture or a positive beta-D-glucan test)...

OBJECTIVE: To assess the usefulness of the "Candida score" (CS) for discriminating between Candida species colonization and invasive candidiasis (IC) in non-neutropenic critically ill patients. A rate of IC <5% in patients with CS <3 was the primary end point. DESIGN: Prospective, cohort, observational study. SETTING: Thirty-six medical-surgical intensive care units of Spain, Argentina, and France. PATIENTS: A total of 1,107 non-neutropenic adult intensive care unit patients admitted for at least 7 days between April 2006 and June 2007...

PURPOSE: Deep mycosis (DM) is an opportunistic infection that can be fatal in immunocompromised hosts. Pancreatic surgery is associated with a high degree of stress and patients who undergo pancreatic surgery are considered to be immunocompromised. This study retrospectively evaluated whether DM affects the clinical course after pancreatic surgery. METHODS: Between January 2005 and April 2007, 67 patients underwent pancreatic surgery. There were 42 males (62.7%) and 25 females (37...

(1-3)-beta-D-glucan (BDG) is a cell-wall polysaccharide component found in most fungi. The measurement of BDG is a useful diagnostic marker for invasive fungal infections. However, it is well known that interfering substances can result in false positive reactions. We encountered a patient who underwent lung transplantation and presented with highly elevated BDG values, despite having no evidence of invasive fungal infection. We therefore hypothesized that elevated BDG values were originated from the gauze products used during surgery...

The frequency of invasive fungal infections caused by yeasts has increased in intensive care units. The most commonly isolated species is Candida albicans, although the number of non-albicans species isolated has increased, and associated mortality is greater in patients infected with these species. The factors that most frequently predispose to invasive candidiasis in the intensive care unit are alterations in skin and mucous barriers (catheters, surgery, intubation, etc.), renal insufficiency, parenteral nutrition, and therapy with corticosteroids or broad-spectrum antimicrobials...

OBJECTIVES: The usefulness of BG as a marker has been reported in patients with pulmonary aspergillosis. However, no data have demonstrated the behavior of BG in sino-orbital IA. We encountered a case of sino-orbital IA and demonstrated changes in the BG level, radiological images, and pathological features. METHOD AND RESULTS: A 63-year-old Japanese woman suffered from invasive sino-orbital aspergillosis. The serum BG level measured immediately before surgery was 37...

A 54-year-old man was admitted to our hospital to be operated on for inguinal hernia, but complained of dry cough and cervical lymph nodes swelling after traveling to California in the United States. The chest X-ray films taken on admission showed consolidations in both lungs. The laboratory data revealed an increase in white blood cell counts with eosinophilia, and elevated ESR, IgE and beta-D-glucan. The biopsied lung specimen by VATS showed epithelioid granulomas consisting of giant cells and eosinophils...

BACKGROUND: Invasive fungal infection remains a major challenge in liver transplantation and the mortality rate is high. Early diagnosis and treatment are required for better results. PATIENTS: We prospectively measured plasma (1 --> 3)beta-D-glucan (BDG) levels in 180 living donor liver transplant recipients for 1 year after surgery. Fungal infection was defined as proposed by the European Organization for Research and Treatment of Cancer/Mycoses Study Group...